More Employers Offer Preventive Drug Lists Over Time
More large employers with high-deductible health plans with health savings accounts offer preventive drug list benefits over time.
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Clayton Irvine, PharmD, MBA, MS, discusses how pharmacists are essential to advancing payer–provider collaboration in value-based care by shaping formularies, standardizing drug reviews, leveraging real-world evidence, and leading pilot programs to optimize patient outcomes and cost-effectiveness.
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Clayton Irvine, PharmD, MBA, MS, emphasized that optimizing value-based access to cell and gene therapies requires standardized care protocols, coordinated transitions between care settings, careful evaluation of prior authorization and financial assistance options, and formulary decisions that balance clinical outcomes with both direct and indirect costs to patients and institutions.
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Jason Bergsbaken, PharmD, MBA, BCOP, explains the value of pharmacist involvement in precision molecular tumor boards and end-of-life care discussions, highlighting their role in ensuring evidence-based therapy selection, patient-specific recommendations, and shared decision-making that aligns treatment with individual goals.
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Clayton Irvine, PharmD, MBA, MS, discusses strategies to address payer-driven biosimilar and prior authorization challenges through integrated digital solutions, while advocating for flexible, regularly reviewed treatment pathways supported by molecular tumor boards and artificial intelligence to balance standardization with personalized, biomarker-driven oncology care.
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AI Meets Medicare: Inside CMS’ WISeR Model With Sanjay Doddamani, MD, MBA, Part 2
August 5th 2025In this second part of his interview with The American Journal of Managed Care®, Sanjay Doddamani, MD, MBA, a former senior advisor to CMMI and founder and CEO of Guidehealth, continues a dialogue on the future of value-based care and the promise—and limits—of AI-enabled innovation, reflecting on challenges like rising Medicare costs and patients’ growing financial burdens.
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A meta-analysis showed that control group outcomes in psilocybin trials for depression were significantly weaker than those in selective serotonin reuptake inhibitor (SSRI) and esketamine trials, suggesting that psilocybin’s large observed treatment effects may be inflated by methodological factors such as functional unblinding and expectancy bias.
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Legal Navigation Services Key to Addressing Disparities in Cancer Care
July 31st 2025A significant number of patients with cancer, caregivers, and health care professionals face significant disparities in legal issues, with the most common needs revolving around health insurance, finances, employment, and disability insurance.
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Price Transparency and Patient Engagement: Social Messaging Matters
This study examined the impact of price transparency and prosocial messaging on patient engagement of price-protected consumers in seeking value-based care.
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